[IP] glitches in medicare part D
Begin forwarded message:
From: Suzanne Johnson <sjohnson@xxxxxxxxx>
Date: January 9, 2006 11:40:19 AM EST
To: dave@xxxxxxxxxx
Subject: glitches in medicare part D
it is really bad in NV also. I know of a woman diagnosed with
pneumonia at the end of Dec who has not been able to get the
antibiotics her MD prescribed. She has spent hours on the phone with
Medicare, healthplan and other folks..still no antibiotics.
Apparently computers and/or databases that need to talk to each other
are not doing so...and it appears that data that was to have been
made available by Medicare either was not available or not accessible.
suzanne johnson pob 788 genoa, NV 89411
http://www.nytimes.com/2006/01/08/national/08medicare.html?
pagewanted=print
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January 8, 2006
States Intervene After Drug Plan Hits Snags
By ROBERT PEAR
WASHINGTON, Jan. 7 - Low-income Medicare beneficiaries around the
country were often overcharged, and some were turned away from
pharmacies without getting their medications, in the first week of
Medicare's new drug benefit. The problems have prompted emergency
action by some states to protect their citizens.
Although there are no hard numbers, concerns expressed by state
officials and complaints from pharmacists suggest a widespread
pattern of problems.
At least four states - Maine, New Hampshire, North Dakota and
Vermont - acted this week to make sure poor people received the
drugs they were promised but could not obtain through the federal
Medicare program.
Gov. Jim Douglas of Vermont, a Republican, said the state would pay
drug claims for low-income people until the federal government
fixed problems in the new program, known as Part D of Medicare.
Michael K. Smith, the state's secretary of human services, said,
"The federal system simply is not working."
On Thursday, the Vermont Legislature passed a bill declaring,
"There is a public health emergency due to the federal
implementation of Medicare Part D, which has resulted in serious
operational problems, causing Vermonters to be turned away at the
pharmacy without the drugs they need."
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"Many are being charged unaffordable co-payments for prescription
drugs - co-pays much higher than they are supposed to be. Too many
of them are leaving pharmacies without their prescriptions."
Thomas T. Noland Jr., a spokesman for Humana Inc., a major national
insurer, said that some problems were "to be expected in a new
program with lots of new enrollment taking effect all at once."
Cynthia G. Tudor, a senior Medicare official, told insurers on
Wednesday that they must "immediately make improvements" to "ensure
that all beneficiaries get their prescriptions filled at the point
of sale."
In a memorandum to insurers, Ms. Tudor said she had received
"numerous reports" that they were "inappropriately denying some
scripts," or claims. In many cases, she said, insurers are not
providing the data that pharmacies need to file claims and get paid.
Dr. Mark B. McClellan, administrator of the federal Centers for
Medicare and Medicaid Services, said on Saturday that he was
working closely with states to address their concerns and to help
individual patients. "We are filling close to a million
prescriptions a day, including hundreds of thousands for low-income
beneficiaries," Dr. McClellan said. "Many, many people are getting
the prescriptions they need."
But in an interview on Friday, Stan Rosenstein, the Medicaid
director in California, said: "We are hearing more and more
complaints. A significant number of people are not getting their
prescriptions. That has us very troubled."
Drug benefits are delivered by private insurers under contract to
Medicare. The federal government is supposed to compute the subsidy
available to each low-income beneficiary. But Michael Polzin, a
spokesman for Walgreens drug stores, said that, in many cases, that
information had not been shared with insurers or pharmacists.
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Beverly R. Churchwell, an aide to the Alabama commissioner, said:
"Some Medicare beneficiaries have not been able to get their
medications. They are being turned away at the pharmacy."
John J. Morris, 42, of Ware, Mass., who has diabetes and multiple
sclerosis, signed up for a Medicare drug plan on Nov. 16. The
insurer told him his co-payments would not exceed $5, he said, but
at the pharmacy this week, he was told he had to pay $23 for each
of three drugs.
"I could not afford it," Mr. Morris said, "so I was not able to get
my insulin or my M.S. drug."
In Oregon, Sandy K. Hata, a field manager for the State Department
of Human Services, said: "We've had calls from people in tears who
could not get their medications. These people were being asked to
pay a $250 deductible and hundreds of dollars in co-payments."
Jane-ellen A. Weidanz, the Medicare project manager at the Oregon
Department of Human Services, said, the $250 deductible "is hitting
people very hard," adding: "People are very angry and very upset.
They are yelling at us. They feel that we lied to them. They feel
Medicare lied to them. They feel they cannot trust anything we say
about this program."
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